The federal government will take a look into New Mexico’s behavioral health services, according to the four Democratic members of the state’s congressional delegation. In a letter last month to Sens. Tom Udall and Martin Heinrich and Reps. Michelle Lujan Grisham and Ben Ray Luján, the federal Department of Health and Human Services Inspector General Daniel Levinson confirmed the upcoming review. “OIG will review the extent to which behavioral health providers are included in the States’ managed care plans and the types of care offered by these providers,” Levinson wrote in the June 28 letter.
There’s no getting around it. Four years after Gov. Susana Martinez’s administration charged 15 behavioral health organizations with potentially defrauding the state’s Medicaid program, its case has experienced a slow-motion unraveling. No Medicaid fraud was ever found. And those eye-popping estimates that added up to $36 million the organizations had overbilled Medicaid? In the summer of 2017, the Human Services Department (HSD) is seeking drastically lower reimbursements for overbilling the public health insurance program for low-income residents, a review of public records and state court documents has found.
After testimony from officials from three nonprofits that provided behavioral health services which were targeted with fraud allegations but later cleared by the Attorney General,a second New Mexico lawmaker called for state Human Services Department Secretary Brent Earnest to resign. “This is just morally repugnant behavior that this administration, this department, has done,” state Rep. Christine Trujillo, D-Albuquerque, said Wednesday at an interim Legislative Health and Human Services Committee meeting. “It’s criminal and obscene.”
Trujillo and eight other state lawmakers listened to the heads of three of the 15 behavioral health organizations that were infamously accused of “credible allegations of fraud” in 2013 by HSD’s then-Secretary Sidonie Squier. The department cited an audit from Boston-based Public Consulting Group that found $34 million in Medicaid fraud between the 15 providers. Squier cut off Medicaid funding from the providers, but the Attorney General’s Office has since cleared all from any wrongdoing.
Mary Kay Papen is the President Pro Tem of the New Mexico State Senate and a Democrat who represents District 38. The public should continue questioning the timing of a vote by University of New Mexico regents to change the governing structure of UNM’s Health Sciences Center. These regents, appointed by Gov. Susana Martinez, claim quick action was needed to streamline university operations and create efficiency. To the best of my knowledge, no thoughtful deliberative process involving input from stakeholders and consensus building took place before this major change. I am worried that this is yet another ill-conceived move by public officials that could end up jeopardizing the HSC, a key player in a core segment of the state’s health care infrastructure.
All 15 of the behavioral health providers that the state Human Services Department cut Medicaid funding from in a controversial action three years ago have now been cleared of allegations of fraud. Attorney General Hector Balderas told legislators Tuesday his investigation into the final two providers found no allegations of fraud. These final two providers are Pathways and TeamBuilders. HSD cut off Medicaid funding to the state’s 15 behavioral providers in 2013, citing “credible allegations of fraud” after the state department contracted an audit with Boston-based Public Consulting Group. Some of the providers shut their doors after the state halted their federal Medicaid funding, causing a shakeup in the behavioral health system around New Mexico.
Democratic members of New Mexico congressional delegation announced they are calling on the federal government to investigate the behavioral health shakeup from two years ago. The call came in the form of a letter from two U.S. Senators and two of the three members of Congress. All four are Democrats. The letter to U.S. Department of Health and Human Services Secretary Sylvia Burwell cites Attorney General Hector Balderas’ investigation that cleared 13 of 15 providers; the investigation into the final two providers is still ongoing. Last week, Balderas announced ten more providers were cleared, in addition to the three who had been cleared the year before.
A prominent state senator is calling for Gov. Susana Martinez’s administration to be investigated for shutting down Medicaid funding from 15 behavioral health providers in 2013. Sen. Howie Morales, D-Silver City, made the statements following an investigation by Attorney General Hector Balderas’ that cleared 10 of the providers of fraud this week. Three others had already been cleared by Balderas’ office. “The public deserves some answers of what took place, why did it took place and the justification of this tremendous impact to the state of New Mexico,” Morales told NM Political Report Tuesday. The state Human Services Department shut off funding from the 15 providers in 2013 after an audit from Boston-based Public Consulting Group found “credible allegations of fraud” in an audit that year.
The Attorney General’s office cleared ten more behavioral health providers of allegations of fraud years after a shakeup of the state behavioral health system based on “credible allegations of fraud.”
A letter from Attorney General Hector Balderas to legislators delivered Monday morning announced that his office’s investigation found no “pattern of fraud for any of the ten completed investigations.”
This brings the total amount of firms cleared to 13. Balderas’ letter said that his office did find “some regulatory violations” but nothing that rose to the level of what the Attorney General’s office could prove as fraud. “We came to different conclusions on many of the alleged violations cited in the [Public Consulting Group] report, and ultimately did not find that the violations that we were able to substantiate reflected a deliberate or intentional pattern of fraud,” the letter says. The letter goes on to say the results will be referred to the state Human Services Department for administrative action on that department’s behalf. A statement from the HSD public information officer vowed to continue to fight fraud.